Kapriniotis Konstantinos, Loufopoulos Ioannis, Apostolopoulou Aikaterini, Anderson Paul C B, Papaefstathiou Efstathios
Department of Urology, Whipps Cross Hospital, Barts Health NHS, London E11 1NR, UK.
Urology Department, Ipswich Hospital, Health Rd, Ipswich IP4 5PD, UK.
J Clin Med. 2025 Apr 21;14(8):2854. doi: 10.3390/jcm14082854.
Urethral strictures significantly impact patients' quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing fibrosis and stricture recurrence. Paclitaxel's antiproliferative and antifibrotic properties inhibit excessive collagen deposition, improving long-term outcomes. DCB treatment is now included in guidelines for managing recurrent bulbar strictures less than 3 cm in length. Recent studies, including the ROBUST trials, have demonstrated the efficacy of Optilume in improving the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). DCB has also shown a significant reduction in reintervention rates compared with endoscopic treatments in long-term studies, confirming its safety profile. However, the durability of DCB in complex or longer strictures remains uncertain, and its role as a salvage therapy post-urethroplasty requires further investigation. DCB represents a promising, cost-effective advancement in managing recurrent bulbar urethral strictures, particularly for patients unsuitable for urethroplasty. Future research should focus on refining patient selection criteria and exploring indications for other anatomical sites.
尿道狭窄严重影响患者的生活质量，诸如直视下尿道内切开术（DVIU）和扩张术等内镜治疗显示出较高的复发率。药物涂层球囊（DCB）治疗在扩张后局部递送紫杉醇，是一种旨在减少纤维化和狭窄复发的创新、微创方法。紫杉醇的抗增殖和抗纤维化特性可抑制过多的胶原蛋白沉积，改善长期疗效。DCB治疗现已纳入长度小于3厘米的复发性球部狭窄管理指南。包括ROBUST试验在内的近期研究已证明Optilume在改善国际前列腺症状评分（IPSS）和最大尿流率（Qmax）方面的疗效。在长期研究中，与内镜治疗相比，DCB还显示再次干预率显著降低，证实了其安全性。然而，DCB在复杂或较长狭窄中的耐久性仍不确定，其作为尿道成形术后挽救治疗的作用需要进一步研究。DCB是复发性球部尿道狭窄管理中一种有前景、具有成本效益的进展，尤其适用于不适合尿道成形术的患者。未来的研究应侧重于完善患者选择标准，并探索其他解剖部位的适应证。
